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Key Highlights 03 cumulative cases (00 probable 03 confirmed)

All (03) confirmed cases have died (CFR =100%)

Today is day 9 since the death of the last confirmed case who passed on the 13 June 2019 while on transfer to the DRC

for further management

There are 108 contacts under follow up

o 107 were followed up today

01 suspect case on admission in ETU

Active case search and death surveillance are ongoing in the health facilities and the communities as the district response

team continue to investigate all alerts

Cumulatively 771 individuals have been vaccinated: 74 contacts, 497 contacts of contacts and 176 frontline health

workers.

38 individuals were vaccinated today: 06 contacts and 32 contacts of contacts

1. Situation update

Cases

03

Deaths

03

EBOLA VIRUS DISEASE IN UGANDA 22 June 2019 as of 20 00 Hrs SitRep #11 Situation Report

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EPIDEMIOLOGICAL SUMMARY

Background

On 11th June 2019, the Ministry of Health of Uganda declared the 6th outbreak of Ebola Virus Disease (EVD) in the country

affecting Kasese district in South Western Uganda. The first case was a five-year-old child with a recent history of travel to the

Democratic Republic of Congo (DRC). This child was one of 6 people that travelled from the DRC while still being monitored

as suspect cases following a burial of the grandfather who succumbed to EVD. The child was ill by the time he crossed into

Uganda and the mother took him for medical care at Kagando hospital in Kasese district with symptoms of vomiting blood,

bloody diarrhea, muscle pain, headache, fatigue and abdominal pain. The child tested positive for Ebola Zaire by PCR and he

later died on 11th June 2019. Two other members of the family, a grandmother and 3-year-old brother also tested positive for

Ebola on 12 June 2019 and the grandmother died later the same day. The 3-year-old brother also died on the 13 June 2019 since

then no new confirmed EVD case has been reported in Uganda. There is one EVD suspect case in the ETU with negative

laboratory results on 1st sample.

Figure 1: Movement of the EVD cases from Congo into Uganda

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Table 1: Summary of Ebola virus Disease outbreak in Kasese, June 2019

SUMMARY OF CASES (as of 21/June/2019) Number

New suspect cases today 00

New deaths today 00

Cumulative cases (probable and confirmed) 03

Probable 00

Confirmed 03

Cumulative deaths (probable and confirmed) 031

Health facilities 03

Community 00

Deaths among confirmed cases 03

Number of cases on admission (probable and confirmed) 00

Probable 00

Confirmed 00

Suspect cases on admission under investigation 01

Runaways from isolation 00

Cumulative number of contacts listed as of today 108

Number of contacts that have completed 21 days 00

Number of contacts under follow up 108

Number of contacts followed up today 107

Cumulative number of individuals vaccinated 771

Number of contacts vaccinated 74

Health workers 3

Community 71

Number of contacts of contacts vaccinated 497

Health workers 00

Community 497

Number of front-line health workers vaccinated 176

Number of contacts vaccinated today 06

Health workers 00

Community 06

Number of contacts of contacts vaccinated today 32

Health workers 00

Community 32

Specimens collected and sent to the lab. Today 00

Cumulative specimens collected 20

Cumulative cases with lab confirmation 03

Cumulative samples tested negative 11

Specimens with pending results 00

Date of discharge/death of last confirmed case 13-June-2019 1 includes 1 death in the DRC 2 includes 6 repeat samples

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Figure 2: Epidemic curve of Ebola Virus Disease outbreak in Kasese, June 2019

Coordination

Today the daily District Task Force meeting was not held. However, a coordination meeting with all key players and field teams

was held with the aim of setting strategies and mechanisms for the response.

Key issues discussed

- District EVD response plan not yet funded

- Involvement of all political leaders in the fight against Ebola.

- Discussed on grouping and Teaming according to activates (facility based and community-based activities)

- All partners are supporting MoH and should comply with TOR by MoH

- There should be one list of contacts shared by surveillance team and vaccination.

- Intensify community dialogue

- The community demands to be addressed by their local leadership.

- There is need to share names of areas or places that are affected by Ebola in DRC with Immigration offices for easy

identification of individuals from such places at the PoE.

- All high-risk contacts should be vaccinated immediately within two days

Surveillance

A total of 107 out of 108 contacts were followed up today. None had developed EVD signs or symptoms. One contact

moved to Kamwokya in Kampala and she was identified and has not developed symptoms. This contact is being

followed by the Kampala City Council contact tracing team.

No alert was received today. The cumulative total of alerts received is 13 (five suspects, 7 none case and one contact)

Active screening was ongoing at 6 official border points, 5 bus terminals, 1 airfield, and 5 porous border points.

Laboratory

The Laboratory received results of one sample collected on 21 -6-2019 and it was negative. There are no pending

results.

No sample was collected today. The cumulative number of samples referred to date is 20 including 6 repeats

The mobile lab at Bwera Hospital is now set to run onsite testing of duplicate sample (specifically for Ebola Zaire strain)

2. Public Health Actions to date

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Case management

There is one suspect case on admission today still under investigation with a negative result on the first test. Second

sample will be taken tomorrow and tested using the onsite laboratory.

Risk Communication and Community Engagement

Conducted 1 radio talk show on Kasese Guide Radio

Engaged 4 prison officers of Rusese and Nyabirongo prisons and discussed EVD basic facts and developed a

schedule for engagements of prisons communities in Kasese.

Secured appointment with the local leadership of Mirami village to discuss community hostilities towards the

ongoing ring vaccination.

Developed a schedule for orientation of school headteachers on EVD basic facts.

Visited 9 villages and sensitized 2,200 people on EVD

Conducted one community meeting in Kyabolokya II village in Mpondwe Lhubiriha town council and sensitized

86 people on EVD.

Planned Activities for Risk Communication and Community Engagement on 23rd June 2019

Film van in Bukonzo East

Community dialogues in Bukonzo West

Community drives Busongora Noth and Bukonzo West

Visit to churches in Bukonzo East and West

Logistics

Received two full PPE kits.

Received 10 beds and 10 mattresses from WHO.

Issued 210 EVD vaccine doses.

WASH

Followed up 10 public places that did not previously have hand washing facilities. Four had the facilities and 6

promised to provide the facilities

Visited 13 schools and mentored on hand washing. Seven government schools have water without chlorine and 6

private schools promised to buy hand washing facilities

Followed up on Mawa market inspection of hand washing facilities. Two gates had washing facilities while the

other two did not have hand washing facilities. The market officials promised to provide the facilities next week.

WASH Planned activities for tomorrow

Assessment of hand washing facilities at places of worship

Vaccination

Cumulatively 771 individuals have been vaccinated including 71 contacts of whom 3 are health workers, 497 contacts of contacts

and 176 frontline health workers. Today 38 individuals were vaccinated including 6 contacts and 32 contacts of contacts. Forty-

nine contacts were traced for vaccination today however, 43 contacts could not be vaccinated for the following reasons (figure

2.0)

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Figure 2.0 Distribution of reasons for not being vaccinated

The 10 individuals already vaccinated were vaccinated in the preparedness phase. One bedridden contact had suspected hepatitis

while another suffered from typhoid. The condition of the third bedridden contact was not known but it was not suggestive of

EVD. One of the two contacts who were not known by the community was identified in Kamwokya, Kampala and is being

monitored by the KCCA contact tracing team. The other contact could not be traced by both the vaccination and contact tracing

teams. It is possible she could have returned to the DRC. The teams will continue to search for this contact tomorrow. The other

contacts who could not be reached today will be followed up today and vaccinated.

The contact follow-up rate is encouraging and has been consistent for the last 9 days.

Currently, social mobilisation, WASH and IPC have been intensified throughout the entire Kasese District and have been so

instrumental in containing the EVD threat. A competent case management team is on standby to manage all cases identified as

well as a laboratory sample management system that is able to provide a definitive diagnosis within 24 hours of identification

of a case.

The vaccination campaign has supported containment of the threat by forming two protective rings around contacts to the

three confirmed cases identified in Uganda as well as those contacts who attended the burial and are linked to the grandfather

who died in DRC. Many Frontline health workers have also been vaccinated.

Surveillance systems have been enhanced to support Community Based Disease Surveillance (CBDS), Points of Entry

surveillance, active case search, Event Based Surveillance including mortality surveillance and alerts management.

However, there is need to support PoE surveillance especially in identifying and manning screening points at previously

unknown ground crossing points. Screening at other crossing points still occurs during the day and hardly at night. The persons

who eventually turned positive for EVD crossed over from the DRC into Uganda during the night!

Whereas CBDS and EBS structures have been activated, they are still not strong enough to effectively contribute to early

identification and reporting of cases. A local coordination mechanism for CBDS and EBS is still not yet well institutionalised

to support EVD surveillance. Again, the VHTs who were activated to lead the implementation of this system (2 per village)

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3. Current Risk Assessment

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seem inadequate and less motivated to support this system.

Overall, the risk of spread of the current outbreak within Kasese District remains low as all high-risk contacts have been

identified and are closely monitored. Most of these contacts have been vaccinated. However, the risk of importation of any

other EVD cases from DRC into Uganda is still imminent and a high possibility, especially following the ongoing clashes

between the Lendu and Hema tribes in Eastern DRC, the epicentres of the EVD outbreak in DRC.

We acknowledge the support from the following partners in response to Kasese Ebola outbreak.

Thematic Area Partner

Coordination WHO, UNICEF and Save the Children

Surveillance IRC, AFENET, WHO, CDC, Uganda Red Cross

Laboratory CDC Uganda

Risk Communication UNICEF, WHO, UPDF, BRAC-Uganda, USAID CHC-Obulamu,

URC, Save the Children, St. John’s Ambulance,

Case Management WHO, MSF

Infection Prevention & Control/ WASH WHO, UNICEF, Baylor Uganda,St. John’s Ambulance, Save the

Children, Uganda Red Cross, IRC

Psychosocial Support AFENET, WHO

Logistics WHO, UNICEF, Baylor Uganda, WFP, Uganda Red Cross, BRAC

Uganda

Security UPDF, Uganda Police

Points of Entry WHO, AFENET, Uganda Red Cross, IRC, IOM

Vaccine and therapeutics WHO, MSF

Challenges

District response plan is not yet funded

Refusal of vaccination among contacts and contacts of contacts

Some unofficial border points are not operational due to limited logistics.

There are no security personnel at PoEs except the airfield and Mpondwe.

Uncertainty of the lead agency responsible for facilitating personnel at the border points.

Recommendations

MoH should expedite funding of district response plan to enable increased community led response

interventions.

The psychosocial and risk communication teams should work closely with vaccination teams to re-engage the

resistant communities.

Vaccination team should meet with surveillance team to harmonize the definitions of contacts and contacts of

contacts as well as the list of contacts

NTF should guide on the facilitation of intending security deployment at all 30 PoEs

4. Partnerships

5. Challenges and Recommendations

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Surveillance has been intensified in the district and community awareness has also been heightened. The new strategy of

response teams teaming will ease on transport challenges and increase on political involvement. Harmonisation of risk

communication and vaccination teams on message contents will strengthen community engagement and myths and

misconceptions against vaccination. Kasese remains at high risk for an Ebola outbreak given the unofficial points of entry with

high volume cross boarder movements.

6. Conclusion